Answer: Start with the coverage commitment, operational responsibilities, commercial payment terms and actual collections. Consider financial support alongside the exclusive agreement and the group's strategy. For this offer, keep unpaid preop clinic coverage and the absence of a minimum volume commitment explicit in the discussion. Whether the commercial payer mix makes the arrangement worthwhile remains an open question.
The short answer
An ASC developer and anesthesia practice advisor says the assessment should begin with a feasibility study and impact analysis using numbers and data. The advisor also identifies operational management and obtaining managed care rates and contracts as responsibilities that come with bringing the anesthesia service in house.
Authors of an ASC coverage analysis say the arrangement should specify required coverage and expected hours. That includes on-site coverage, off-site or on-call time, administrative services and medical directorship responsibilities.
A revenue cycle specialist emphasizes comparing actual payer payments with the commercial contract. The financial discussion therefore includes both what the contract promises and what the group receives. A favorable impression of payer mix leaves those questions unanswered.
What usually goes wrong
A business contracting author identifies two recurring mistakes: treating negotiations for financial support as though they were the entire exclusive agreement, and overlooking how exclusivity relates to overall group strategy.
The revenue cycle specialist identifies another distinction: contractual payment expectations and actual payments. The specialist says to check whether the payer followed the contract, including payment for additional items specified in its terms.
For the proposed unpaid clinic assignment, the practical question is how that responsibility fits into required coverage and expected hours. With no minimum volume commitment, expected activity also remains a question for the partner discussion.
What a veteran checks first
- Coverage scope: the coverage analysis authors identify required services, on-site and on-call time, administrative duties, medical directorship responsibilities and expected hours.
- Financial assessment: the ASC advisor calls for a feasibility study and impact analysis grounded in numbers and data.
- Commercial payment terms: the revenue cycle specialist says a contract may specify a per-unit rate and payments for physical status, modifying units and qualifying circumstances. Those terms can be loaded into the revenue cycle system.
- Payment experience: the specialist says to compare actual payments with the contract, including any additional payments its terms require.
- Operational responsibilities: the ASC advisor identifies managing the service and obtaining managed care rates and contracts as responsibilities of bringing it in house.
- Financial support and exclusivity: the contracting author connects financial support negotiations with the broader exclusive agreement and overall group strategy.
What the details say
The ASC advisor says an integrated anesthesia practice can receive insurance verification information from the ASC and collect patient prepayments. The advisor associates that integration with reduced bad debt and improved patient collections.
For the owner discussion, keep the proposed collection process concrete: how verification information would reach the practice, how prepayments would be collected and how patient collections would operate. The potential benefits belong alongside the operational responsibilities in the assessment.
Questions to bring to the partner meeting
- How does unpaid preop clinic coverage fit into the required services and expected hours?
- Which operational responsibilities would the group assume?
- What commercial payment terms and actual payment experience are available for review?
- What remains unknown about activity without a minimum volume commitment?
- How would insurance verification, prepayments and patient collections operate?
- How does the proposed financial support relate to the exclusive agreement and overall group strategy?
Sources
- Devona Slater
- Devonna Slater, president and senior compliance auditor, ACE
- James Tekippe, CFA, Michael Schenck, and Ryan Diver
- Mark F. Weiss, JD
- Wes Battiste, ASC developer and anesthesia practice advisor
